Provider Demographics
NPI:1518613058
Name:CALLOWAY, JENNIFER DALTON (LPC)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:DALTON
Last Name:CALLOWAY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MS
Other - First Name:JENNIFER
Other - Middle Name:HAYLEE
Other - Last Name:DALTON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2011 DALE DR
Mailing Address - Street 2:
Mailing Address - City:BLAIRS
Mailing Address - State:VA
Mailing Address - Zip Code:24527-2249
Mailing Address - Country:US
Mailing Address - Phone:434-713-2766
Mailing Address - Fax:
Practice Address - Street 1:1601 FRANKLIN TPKE
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:VA
Practice Address - Zip Code:24540-1031
Practice Address - Country:US
Practice Address - Phone:434-836-8500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-23
Last Update Date:2022-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701011248101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0701011248Medicaid